MD's and Pitocin

babyktchr, BSN, RN · May 28, 2008

Gosh. I guess I always ASSUMED that a provider would examine a patient prior to pitocin use, just in case something has changed (presenting part not in pelvis, or not a HEAD). Our inductions are started in the daytime, and so patients are seen by one or all of the providers in the group. Usually we have a midwife covering the unit during the day...if not, the provider MD is almost always there to examine the patient.

I would imagine you could go into ACOG land and search standards of care for use of pitocin. It just seems more like common sense to me. A week seems way out of reason, and if the patient is that unfavorable, perhaps a ripening agent should be used before the pit. (just my :twocents: )

moosemadness · May 28, 2008

babyktchr, I agree. That is why i wrote in, b/c apparently there are some times when the provider will schedule them(an induction) a week out and b/c we have standing orders they don't always come in right away or before the pit is started. Seems way out there to me. We apparently (i'm farily new in this position, but not new RN) do LOTS of induction's for convenience sake or pt just being sick of being prego. Part of my issue with things here. Thanks for your info.

BirthCenterRN · May 28, 2008

Our orders used to say cervical exam by MD within the last 24 hours. They now extended it to 72hours (ie seen on friday and induced on monday). The nurse does the initial exam right before the pitocin is started. This is the same policy for cytotec/gel. In the ripening scenario, when the nurse does the sve and the patient is >3cm or Ruptured we go straight to pit.

Hope this helps

CEG · May 29, 2008

When our MDs schedule an induction they call the nurses who write it up in a book and also write out the orders. There is no requirement for the MDs to see the patient a certain amount in advance and often they do not see them until they deliver. I sort of wonder why the nurses are the ones writing the orders, making the assesments, making the treatment decisions, etc when it should really be the MD's responsibility.

babyktchr, BSN, RN · May 29, 2008

:yeahthat: :yeah: :thnkg:

mitchsmom · Jun 1, 2008

When our MDs schedule an induction they call the nurses who write it up in a book and also write out the orders. There is no requirement for the MDs to see the patient a certain amount in advance and often they do not see them until they deliver. I sort of wonder why the nurses are the ones writing the orders, making the assesments, making the treatment decisions, etc when it should really be the MD's responsibility.

Ours is similar, except we don't write orders when we put the induction in the book.

When mom just comes in, we assess/examine cervix/ get a strip, etc. and call for orders at that time. Often our MD's don't see pt until they deliver (and that could be all of 10 minutes).

crysobrn · Jun 1, 2008

When our MDs schedule an induction they call the nurses who write it up in a book and also write out the orders. There is no requirement for the MDs to see the patient a certain amount in advance and often they do not see them until they deliver. I sort of wonder why the nurses are the ones writing the orders, making the assesments, making the treatment decisions, etc when it should really be the MD's responsibility.

Yup this is us also. Sometimes patients are seen on wed and then are told to show up to OB next tues or wed for their induction. If they are scheduled then the docs often do not see them until they want to rupture them or til delivery.

Calliegirl · Jun 2, 2008

our patients are seen in the office 24-48 hrs prior to admit for induction. we, the nurses do the assessment, strip, sve, then call the ob for orders.

usually, we cervidil x 12 hours then if needed pitocin is started. 95% of inductions are statred at night. the m.d. usually does not see the pt until am rounds. :loveya:

HazeKomp, BSN, RN · Jun 22, 2008

hmmm...

our policy requires prenatal records, presentation confirmed by VE (RN or MD ok), reactive tracing, confirmed gestational age (again, by PNR & US)....

our docs do NOT see their patients before starting pitocin...

see them for the delivery...

Calliegirl · Jun 23, 2008

we, also, have an updated copy of prenatals on admit. our docs only come in at night if we call and tell them we need them. just last week i did a cervidil on a patient. reactive strip before palcement then no variabiltiy, and lates about 2 hours after cervidil, i pulled the cervidil, lt side, o2, fluid bolus, sve...nothing worked. called the m.d. told him what was happening, did a stat c/s... cord gas ph 7.29 apgars 9-9. mom and baby did well. :redbeathe

imfree · Jun 24, 2008

Hi! I have not ever heard or read of a "rule" re: MDs seeing a patient at a designated time prior to induction of labor. Sure would be reasonable, but as most of us who have worked l and d for any length of time know - induction is almost always about pt and/or doctor convenience, not about what is reasonable!! lol!! Anyway, I have seen many patients scheduled for induction up to 6 weeks ahead of time (we do lots of inductions and the book fills up fast) Patients often have not been seen/examined by the doc for 5-7 days before induction. It is up to the RN to determine presentation, cervical status, etc and notify the doctor if induction orders do not seem appropriate for the situation. The physician usually sees the patient for the first time when AROM is indicated (strangely - that is usually at a.m. rounding time!) Then, they usually see them again at delivery time and that's it! Best of luck in updating your protocols!

RN